The CMS should improve the reliability of data it uses to calculate the return on investment for measuring the effectiveness of the Medicare Integrity Program, according to a new report from the Government Accountability Office (PDF).
GAO urges CMS to improve MIP-related data
The MIP, as it's called, is used to address the fraud, waste and abuse that lead to improper payments in the Medicare program. For this report, GAO auditors were asked to examine how effectively the CMS uses MIP funding to support the program's activities between the years 2006 and 2010, and how the agency assesses the MIP's effectiveness. The study also reported on what factors the CMS considers when it allocates MIP funding.
“One way that CMS already measures effectiveness is ROI, which CMS calculates as savings from an activity in relation to expenditures,” the report noted. “CMS calculates ROI for most of its MIP activities, but the data it uses has two flaws.”
The first flaw is that the ROI calculations are not updated when program expenditure data—which GAO researchers said are an essential component of the calculation—are updated. Consequently, this could lead to an incorrect calculation of the ROI. And the second defect is the CMS does not have reliable information to determine the amount of MIP spending by activity for one type of contractors that received about 22% of total MIP funding in fiscal 2010. “It will be important for CMS to correct these flaws to ensure reliability in ROI reporting,” the study said.
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